2017
Employee Benefits Guide
Welcome
Introduction
Hillsborough County understands that your benefits are important to you and your family. Helping you understand
the benefits available to you is essential. This Benefits Guide provides a description of our benefit program.
This guide is not an employee/employer contract. It is not intended to cover all provisions of all plans, but rather a
quick reference to help answer most of your questions. Please see the carrier benefit summaries for more details.
Included in this guide are summary explanations of the benefits, as well as contact information for each provider. It
is important to remember that only those benefit programs for which you are eligible and have enrolled apply to
you.
We encourage you to review each section and to discuss your benefits with your family members. Be sure to pay
close attention to applicable co-payments and deductibles, how to file claims, preauthorization requirements,
participating networks and services that may be limited or not covered (exclusions). We hope this guide will give
you an overview of your benefits and help you be better prepared for the enrollment process.
Benefits Eligibility
Employee
Benefit eligible employees are provided an opportunity to participate in the Hillsborough County sponsored benefits
program upon initial hire and annually during Open Enrollment. You are eligible for health insurance benefits on the
first day of the month following 60 days of employment if you are a permanent employee regularly scheduled to
work 20 or more hours per week. Most other benefits are effective on the first day of the month following 30 days
of employment. (The waiting period for disability insurance is 6 months.) Please refer to the following guidelines
regarding eligibility and election changes.
New employees must enroll in their benefits within 30 days of their date of hire.
Dependent
A dependent is defined as a covered employee’s legal spouse, a domestic partner (certain rules apply), or a
dependent child of the employee or employee’s spouse. Dependent children will be covered up until their 26th
birthday.
A dependent child is defined as:
 A natural child
 A step-child
 A legally adopted child
 A child of your domestic partner (certain rules apply)
 A child placed for adoption
 Grandchildren up to 18 months of age if the parent is also a covered dependent on the plan
 A child for whom legal guardianship has been awarded to the covered employee or the employee’s spouse
 Unmarried children of any age who become mentally or physically disabled before reaching the age limit.
Supporting documentation is required at the time of continuation beyond limiting age.
Full names and social security numbers for all covered dependents must be added on Oracle Employee Self
Service under “Personal”.
FL Statute 627.6562 Dependent Coverage: Health insurance coverage is available for dependents ages 26 to 30.
Please contact the Human Resources for more information.
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Qualifying Event
Coverage elections made at Open Enrollment cannot be changed until the next Open Enrollment period. The only
exception to this IRS Section 125 Rule is if you experience a “Qualifying Event.” A Qualifying Event allows you to make
a change to your benefit elections within 30 days of the event.
Examples of Qualifying Events include, but not limited to:
 Marriage
 Divorce or legal separation
 Birth, adoption, or legal custody of a dependent child
 Involuntary loss/gain of other group insurance coverage
 Death
 Eligibility requirements reached for Domestic Partner Benefits
If you experience a Qualifying Event, contact Human Resources and submit all requirements within 30 days of the
event, or go online through Oracle Benefits Enrollment to adjust your benefits accordingly. Documentation must
be supplied to Benefits Support Services via fax, email or in person .
YOUR Responsibility
Before you enroll, make sure you understand the plans and ask questions if you do not. After you enroll, you should
always check your paycheck stub to make sure that the correct amount is being deducted and all of the benefits you
elected are included.
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Medical, Dental & Vision Payroll
Deductions
Bi-Weekly Payroll Deductions
Open Access Plus Plan
Coverage Now
Choice Fund with
HSA
Employee Only
$140.54
$88.20
$45.55
Employee + Spouse
$232.62
$137.15
$55.73
Employee + Child(ren)
$222.92
$129.39
$54.28
Employee + Family
$283.98
$151.68
Medical
Vision
Humana
VisionCare
Plan
Employee Only
$1.97
Employee + 1
$5.81
Employee + Family
$7.77
The Hillsborough County Cafeteria Plan
The County’s cafeteria plan provides you with a monthly
benefit of $210, which may be used to offset the purchase
of health, dental, vision, life, or to invest in a deferred
compensation plan. You can also receive the amount as
additional compensation. With the County’s cafeteria
plan, you choose the benefits you want or opt out of our
plan if you don’t need the coverage. If you do not use
the cafeteria plan to offset your benefits, please be aware
that the amount you receive is taxable income.
Humana Prepaid HS205
(DHMO)
Humana Prepaid
HS195 w/
implants
(DHMO)
Employee Only
$5.29
Employee + 1
Employee + Family
Dental
$71.24
Humana Dental
Advantage AVN1
Humana PPO
Elite
Preferred
500
$7.45
$8.13
$11.29
$8.27
$13.95
$16.03
$22.26
$12.41
$18.14
$24.39
$39.41
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Medical Benefits
MyCigna.com
We encourage you to register on mycigna.com. This site provides you access to your benefits and can help you
find out what is covered, view recent claim activity, find doctors and services and get health advice. On
mycigna.com you also be able to see plan premiums as well as get estimates for the cost of certain services using
the cost of care estimator. Many of the programs are listed below. Click here for the video.
MyCigna Mobile App
You are busier than ever. Cigna understands that. While they can’t wave a magic-wand and make all of the
frustrating, time-consuming aspects of your life go away, they can give you a tool to help make your life easier. And
healthier. Download the mobile app from the Apple Store or Google Play and get access to your ID cards, find a
doctor near you, look up your claims and account balances all while you are on the go! Click here for the video.
Cost of Care Estimator
The estimator is an electronic tool that lets health care professionals create an estimate of your payment
responsibility. The estimate is specific to the treatment or service you are considering, as well as the health care
professional treating you, and is based on a real-time snapshot of your Cigna medical benefits. Only health care
professionals can access the estimator to generate estimates, however you can still go to mycigna.com and click on
“MY HEALTH” in the top toolbar to get estimated medical costs for surgeries and more complicated procedures.
These estimates are not specific to a doctor, but can help you understand the cost of care before going to the doctor.
Healthy Pregnancies, Healthy Babies
If you or one of your dependents are expecting make sure to check out this maternity education program offered
by Cigna. This program is designed to help you and your baby stay healthy during your pregnancy and in the days
and weeks following your baby’s birth. You will receive guidelines for a healthy pregnancy including prenatal care
advice and a list of informative online and telephonic resources. You also have 24 hour toll-free access to registered
nurses. You can receive a $150 rebate for enrolling during the first trimester or a $75 rebate if you enroll by the end
of your second trimester. Call (800) 615-2906 as soon as you know you are pregnant.
Lifestyle Management Programs
Whether your goal is to lose weight, quit tobacco or lower your stress levels, you have the power to make it happen.
Cigna Lifestyle Management Programs can help - and all at no cost to you. Each program is easy to use and available
where and when you need it. And, you can use each program online or over the phone - or both. Take the first step
and call (855) 246-1873 or visit mycigna.com.
Cigna Healthy Rewards
From homeopathic services to natural supplements. Aerobic classes to fitness club memberships, you and your
family have health choices like never before. And as a part of Cigna’s ongoing efforts to help people make healthy
choices that lead to healthier lifestyles, the Cigna Healthy Rewards program offers discounts on a wide variety of
health programs and services - and it’s available at no additional cost to you.
Some services require pre-authorization. It is your responsibility to determine when a pre-authorization will be
necessary. Be sure to discuss with your physician and review insurance contract documents.
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Medical Benefits
Carrier Name
Cigna
Type of Plan
Open Access Plus
Network Access
In Network
Out of Network
Individual
$0
$400
Family
$0
$800
0%
30%
Individual Medical Out-Of-Pocket
Maximum
$3,000
$5,000
Family Medical Out-Of-Pocket Maximum
$6,000
$10,000
Primary Care Physician (PCP) Office Visits
$25 Copay
30% After PYD
Specialist Office Visits
$40 Copay
30% After PYD
Preventive Care Visits
No Charge
30% After PYD
$200 per day for 3 days
30% After PYD
Outpatient Hospital
$200 Copay Per Visit
30% After PYD
Urgent Care Center
$75 Copay
$75 Copay
Emergency Room
$300 Copay
$300 Copay
Independent Lab/ X-ray
0%
30% After PYD
MRI, MRA, CT & PET Scans
0%
30% After PYD
Generic
$15 Copay
30% After Copay
Preferred Brand
$40 Copay
30% After Copay
Non-Preferred Brand
$60 Copay
30% After Copay
25%
30%
Retail Pharmacy (90-day supply)
$30/$80/$120/25%
Not Covered
Mail Order Pharmacy (90-day supply)
$20/$60/$90/25%
Not Covered
Plan Year Deductibles (PYD)
Your Benefit Plan
Coinsurance (when applicable)
Physician Services
Hospital Services
Inpatient Hospitalization
Pharmacy
Self Administered Injectables & Specialty
Medications
Pharmacy Out-Of-Pocket Maximum
$2,500 Individual/$5,000 Family
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Carrier Name
Cigna
Type of Plan
Coverage Now
Network Access
In Network
Out of Network
$1,000
N/A
Individual
$1,000
$2,000
Family
$3,000
$6,000
0%
30%
Individual Medical Out-Of-Pocket
Maximum
$4,000
$6,000
Family Medical Out-Of-Pocket Maximum
$8,000
$12,000
Primary Care Physician (PCP) Office Visits
$25 Copay
30% After PYD
Specialist Office Visits
$40 Copay
30% After PYD
Preventive Care Visits
No Charge
30% After PYD
0% after PYD
30% After PYD
Outpatient Hospital
$200 Copay after PYD
30% After PYD
Urgent Care Center
$75 Copay after PYD
$75 Copay after PYD
Emergency Room
$300 Copay after PYD
$300 Copay after PYD
Independent Lab/ X-ray
0% After PYD
30% After PYD
MRI, MRA, CT & PET Scans
0% After PYD
30% After PYD
Generic
$15 Copay
30% After Copay
Preferred Brand
$40 Copay
30% After Copay
Non-Preferred Brand
$60 Copay
30% After Copay
25%
30%
Retail Pharmacy (90-day supply)
$30/$80/$120/25%
Not Covered
Mail Order Pharmacy (90-day supply)
$20/$60/$90/25%
Not Covered
Coverage Now Benefit Allowance
Per Member Per Year
Plan Year Deductibles (PYD)
Your Benefit Plan
Coinsurance (when applicable)
Professional Services
Hospital Services
Inpatient Hospitalization
Pharmacy
Self Administered Injectables & Specialty
Medications
Pharmacy Out-Of-Pocket Maximum
$2,500 Individual/$5,000 Family
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Medical Benefits
Carrier Name
Cigna
Type of Plan
Choice Fund HSA Plan
Network Access
In Network
Out of Network
Does not apply
Does not apply
Individual
$2,500
$5,000
Family
$5,000
$10,000
10%
30%
Individual Medical Out-Of-Pocket
Maximum
$4,000
$8,000
Family Medical Out-Of-Pocket Maximum
$8,000
$16,000
Primary Care Physician (PCP) Office Visits
10% After PYD
30% After PYD
Specialist Office Visits
10% After PYD
30% After PYD
Preventive Care Visits
No Charge
30% After PYD
Inpatient Hospitalization
10% after PYD
30% After PYD
Outpatient Hospital
10% After PYD
30% After PYD
Urgent Care Center
10% After PYD
10% After PYD
Emergency Room
10% After PYD
10% After PYD
Independent Lab/ X-ray
10% After PYD
30% After PYD
MRI, MRA, CT & PET Scans
10% After PYD
30% After PYD
Generic
10% After PYD
30% After PYD
Preferred Brand
10% After PYD
30% After PYD
Non-Preferred Brand
10% After PYD
30% After PYD
Self Administered injectables
10% After PYD
30% After PYD
Mail Order Pharmacy (90-day supply)
10% After PYD
Not Covered
Coverage Now Benefit Allowance
Per Member Per Year
Plan Year Deductibles (PYD)
Your Benefit Plan
Coinsurance (when applicable)
Professional Services
Hospital Services
Pharmacy
Pharmacy Out-Of-Pocket Maximum
N/A - Included in medical out-of-pocket maximum
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Health Savings Accounts
What is a Health Savings Account?
A health savings account is a savings mechanism that can be paired with a qualified high deductible health plan.
The savings account is funded by pre-tax payroll contributions or it can be funded by after-tax dollars and then
deducted on Form 1040. The funds that you accumulate in the account belong to you and rollover year after
year. The account can be used for qualified medical expenses such as deductibles, copayments, prescriptions,
dental expenses, vision expenses and more.
The maximum amount that you can contribute to the account for the calendar year 2017 is $3,400 if you are
covered under a self only plan or $6,750 if you have family coverage under a qualified high deductible plan (the
Cigna Choice Fund). If you are over age 55 you can add a catch up contribution of $1,000 to the 2017 maximums.
You can contribute what you want, whenever you want.
The health savings account is portable and belongs to you, even if you leave the County.
In order to take advantage of convenient payroll deduction you will need to open a health savings account with
HSA Bank. Your current account will need to be transferred to the new bank and a new card issued. Once you
open your account with HSA Bank you will receive a welcome packet that contains important information about
the account and a debit card. You can use the debit card to pay for out-of-pocket expenses at point of service or
to reimburse yourself for qualified expenses that you may have paid separately. You are responsible for any and
all account activity and must be sure that you can justify withdrawals to the IRS if necessary.
As long as you elect and contribute to an HSA account you will be able to monitor all activity on mycigna.com.
Automatic Claim Forwarding
You can choose to turn on automatic claim forwarding any time during the plan year. This allows Cigna to directly
access your account to pay for medical expenses that are submitted on your behalf. Please be aware that this
feature is not available for pharmacy claims.
Qualified Expenses
In addition to medical, dental and vision expenses, keep in mind that your savings account can be used to pay
premiums for the following specified plans and situations:





COBRA
Qualified Long Term Care Plans (up to specific limits)
Premiums for health coverage during a period of unemployment
Retiree health plan contributions (age 65 or older only under an employer’s retiree health plan )
Medicare Part B, Part D and Medicare Advantage (age 65 and over only)
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Well4Life
Health Assessments and Screenings = $$$$
In 2017, your Wellness Team is launching a new initiative, WELL4LIFE, which focuses on the
importance of all of us to take an active role in managing our own health. However, health is much
more than the physical health that we all likely think about when the word healthy comes to mind.
It also includes the emotional, social, and financial well-being of all our employees. This program
will focus on these four dimensions of health and provide tools for all employees to maximize their
total well-being. WELL4LIFE will strive to create a culture of health, which will aim to improve the
lives of all Hillsborough County employees.
Employees will have the opportunity to earn up to $200 in wellness incentives for preventive
screenings and other wellness activities. More information will be announced in January 2017.
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Vision Benefits
Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone needs to take
good care of their eyes.
The Humana vision plan is being offered as a part of Hillsborough County’s commitment to your well-being.
The Humana program provides affordable, quality vision care. Through the Humana provider network, you can
obtain a comprehensive vision examination, as well as eyeglasses (lenses and frames) or contact lenses, in lieu of
eyeglasses.
Carefully review the vision care program summary provided and take advantage of this very important benefit.
You can call Humana’s Customer Service Center at (800) 865-3676 for any questions you may have regarding
contracted providers or coverage.
Benefits are as follows:
Network Access
In-Network
Out-of-Network
Eye Exam Office
Visit
$10 Office visit
Copay
Up to $35
Reimbursement
Frequency
12 Months
Materials
Lenses (Standard
Plastic)
Single Vision
$15 Copay
Bifocals
$15 Copay
Trifocals
$15 Copay
Frequency
Up to $25
Allowance
Up to $40
Allowance
Up to $60
Allowance
12 Months
Frames
Selected Frames
Frequency
Contacts
$50 Wholesale
(represents
Up to $50
approximately
Allowance Retail
$120 retail)
24 Months
Fitting, Follow Up &
Lenses in lieu of
glasses and frames
(elective)
$150 Allowance
$150 Allowance
Medically Necessary
Contacts
No Charge
Up to $210
Reimbursement
Frequency
12 Months
Custom Website for Humana to find participating vision providers:
http://www.compbenefits.com/custom/hillsborough/
Click here for an informative video on the importance of vision health.
11
Dental Benefits
Your Dental Options
Humana provides you a choice between four different dental plan options: Three Dental DHMO plans and a
Dental PPO.
DHMO
When you select either the Low or High option DHMO plans, you will need to select a contracted dentist for each
family member. When seeking dental care, you must go to your DHMO-selected dentist in order to receive plan
benefits. Plan benefits are not available when you seek care from a non-contracted dentist. The Advantage
DHMO plan is a direct access plan, so you don’t need to select a dentist upon enrollment.
The DHMO offers you comprehensive dental benefits at an affordable payroll deduction. All benefits are subject
to a schedule that outlines copays and charges for services. For a complete summary of copays by procedure and
by plan, please refer to the Humana Dental benefit summary.
If you want to change your Low or High option DHMO dentist, you should contact Humana and make a primary
dentist selection change. If you elect the Advantage dental plan you do not need to select a primary care dentist.
PPO
The PPO emphasizes preventive care—routine oral examinations, cleanings and x-rays– the simplest way to keep
those nasty toothaches away. You can choose a participating dentist or you can choose a dentist outside of the
network. You will always save on out-of-pocket costs when you choose a participating Dentist.
Predetermination Review - Humana can assist you and your dentist by determining which benefits would be
payable for services and procedures. Have your dentist fax your treatment plan to Humana; note that it is a
predetermination review; and Humana will let your dentist know which benefits would be payable under the
plan.
Hillsborough County has a dedicated Website exclusively for our employees!
Humana/CompBenefits to find participating dental providers:
www.compbenefits.com/custom/hillsborough.
Click here for an informative video on the importance of good dental health.
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Dental DHMO Options
Carrier
Humana/
CompBenefits
Low Option
Prepaid HS205
(DHMO)
Humana/CompBenefits
Humana/CompBenefits
High Option
Prepaid HS195 w/
Implants (DHMO)
Advantage AVN1
In-Network
In-Network
In-Network
You must preselect a
dental facility
You must preselect a
dental facility
You do not have to
preselect a dental
facility
$0
$0
$0
You Pay
You Pay
You Pay
$0
$0
$0
In-Network
In-Network
In-Network
Routine Office Visits
$5
$0
$0
Teeth Cleaning
$0
$0
$0
Full Mouth/Panoramic Xrays
$0
$0
$0
See Benefit Summary
See Benefit Summary
See Benefit Summary
Simple Extractions
$0
$5 Copay
$26 Copay
Periodontal scaling
$55 Copay per
quadrant
$50 Copay per
quadrant
$39 copay per quadrant
See Benefit Summary
See Benefit Summary
See Benefit Summary
Dentures
See Benefit Summary
See Benefit Summary
See Benefit Summary
Crowns
See Benefit Summary
See Benefit Summary
See Benefit Summary
Children & Adults
Children & Adults
Children & Adults
See Benefit Summary
See Benefit Summary
See Benefit Summary
Plan
Network Access
Plan Year Maximum
Calendar Year Deductible
(CYD)
Individual / Family
Dental Description
Preventive-Class I
Basic-Class II
Fillings
Endodontics
Major-Class III
Orthodontia
Benefit
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Dental PPO Option
Carrier
Humana/CompBenefits
Plan
PPO Elite Preferred 500
Network Access
In-Network
Calendar Year Maximum
Out-of-Network
$2,000
You Pay
Calendar Year Deductible
Individual / Family
Dental Description
$50 / $150
In-Network
Out-of-Network
Routine Office Visits
$0
$0
Teeth Cleaning
$0
$0
Full Mouth/Panoramic X-rays
20% after CYD
20% after CYD
Fillings
20% after CYD
20% after CYD
Simple Extractions
50% after CYD
50% after CYD
Periodontal scaling
50% after CYD
50% after CYD
Endodontics
50% after CYD
50% after CYD
Dentures
50% After CYD
50% After CYD
Crowns
50% After CYD
50% After CYD
Preventive-Class I
Basic-Class II
Major-Class III
Child
Orthodontia (Under age 19)
Benefit
50% After CYD, $500 maximum per calendar year, $1,000
maximum per lifetime
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Flexible Spending Accounts
Your Flexible Spending Account (FSA)
Eligibility
As an eligible employee, you may enroll in a Flexible Spending Account if you meet the definition of eligibility
described on page two (2).
There are two types of Flexible Spending Accounts:
Health Care and Dependent Care
Flexible Spending Accounts (FSA) help you save money by providing a way to pay for certain types of health care
and dependent care on a pre-tax basis.
How an FSA works
During Open Enrollment, you decide how much money you want to contribute. Up to $2,550 for health care FSA
and up to $5,000 for dependent care FSA if you are married and filing jointly, $2,500 if you are married and filing
separately.
A way to save taxes
Enrolling in an FSA can save you money by reducing your taxable income. Your total savings will depend upon your
family income, tax status and expected amount of health and dependent care costs.
The contributions you make to a Flexible Spending Account are deducted from your wages before your Federal,
State or Social Security taxes are calculated and are not reported to the IRS.
Once enrolled in a health care FSA you will receive a benefit debit card for use when paying for approved medical
expenses at the point of service. There is no need to file a claim! Your entire election is available to you at the
beginning of the plan year, which is January 1st.
Estimate expenses carefully
To receive the greatest savings, you must carefully estimate the amount of eligible out-of-pocket expenses you will
have for the three month period. Once you have estimated the total amount, divide it by number of pay periods
(26). That amount is what you may want to have deducted from your gross pay (before taxes) each pay period to
be used to fund your Flexible Spending Account.
If you terminate employment before the end of the short plan year and have an account balance, you may be
eligible to elect COBRA for this benefit. If you do not elect COBRA, any unclaimed contributions will be forfeited.
You have 60 days from date of termination to file claims for expenses incurred prior to termination. Active
employees have until March 31st of the following year to submit claims.
Rollover Up to $500
Although we still want you to be conservative in your calculations, you will now be able to rollover up to $500 of
unused funds into each plan year. Any amount remaining in the account over $500 will be forfeited according to
IRS regulations.
For Health Savings Account Participants
If you elect to participate in the Choice Fund and elect an HSA deduction (or not) and elect an FSA, the FSA
automatically becomes a limited purpose FSA. The limited purpose FSA is designed to pay for qualified dental and
vision expenses. NO EXCEPTIONS.
15
Flexible Spending Accounts
To estimate your health care expenses for the coming short plan year, be sure to review your monthly health
expenses from last year. Using these figures as a guideline, you can better estimate the amount of expenses
you will most likely incur in this three month period..
As you incur medical expenses that are not fully covered by your insurance, you may submit your expenses
for claims or Benefits Card transactions using one of the following options:
1) Explanation of Benefits from your insurance carrier after a claim has been paid;
2)Detail claim from the provider (ex: physician/dentist)
on the services form with all information related to the service and expenses;
3) A prescription form that you receive from the pharmacy with the information on each prescription you
are submitting;
4) A computer form from a pharmacy for prescriptions filled at that pharmacy with all detail information
related to the prescriptions/date/costs.
Eligible expenses
According to IRS regulations, the following are eligible expenses under a Health Care FSA. These expenses
must be incurred during the short plan year and must not be eligible for reimbursement from insurance
policies or any other source. Also, expenses can only be incurred by you, your spouse or any dependent (if
you furnished more than over one half of the dependent’s support during the short plan year).
Examples of eligible expense include:
 artificial limbs, eyes, etc.
 chiropractic care, licensed services/practitioner
 deductibles/co-insurance (if not reimbursed from another source)
 dental fees, including braces, treatments, etc.
 prescription drugs
 durable medical equipment, wheelchairs, etc.
 prescription eyeglasses and contact lenses, solutions, enzymes
 hearing aids and batteries
 maternity (delivery) expenses, midwife
 nursing home (for medical reasons)
 ophthalmologist, optometrist services
 orthodontic expenses
 orthopedic shoes and corrective devices
 physical examinations
 physician fees
 radial keratotomy (PRK, LASIK)
 smoking cessation programs and prescription medication
 transportation, tolls or parking expense for medical care vaccinations, immunizations
For a complete list of eligible and ineligible expenses, visit www.irs.gov and refer to Publication 502.
16
A closer look at Dependent Care FSA’s
Dependent Care Flexible Spending Accounts may be used to pay for expenses you incur for the care of
dependent children under age 13 or any disabled dependent who lives with you and who you claim on your
taxes. If you use Dependent Care services for a child, you know how much you need to budget for this expense
every month. With an FSA, you set aside money to pay this expense with pre-tax dollars.
What’s best for you?
Your total savings will depend upon your family income, tax status and total expenses. If you have Dependent
Care expenses, you may choose to claim a tax credit when you file your Federal taxes rather than contribute
to a Dependent Care FSA. Your own circumstances will determine whether using a Dependent Care FSA or the
Federal income tax credit will be better for you.
Contribution limits
The Dependent Care Flexible Spending Account allows employees to set aside pre-tax dollars to pay for workrelated child care expenses or adult dependent care. Up to $5,000 can be set aside for this purpose if you are
single or married and file a joint tax return. If you are married and you and your spouse file separate tax
returns, the maximum that each of you can contribute is $2,500.
17
Employee Assistance Program (EAP)
Employee Assistance Program (EAP)
From time to time, many of us face issues at work or at home that we are not sure how to solve. These can
range from employer problems to marital problems or even substance abuse. That’s why Hillsborough County
offers its employees a confidential Employee Assistance Program administered by Cigna.
This program offers you professional assistance in dealing with almost any life issue. From stress or depression
to legal or financial issues, the Hillsborough County EAP can help!
These services are available to you and your dependents by calling a toll-free phone line open 24 hours a
day/7 days a week. All conversations are confidential and private. In addition to telephonic support, each
employee and family member can receive up to 6 sessions with a counselor per occurrence each plan year.
Types of issues for which you can obtain support:

Core Services, such as general counseling for stress, depression, family issues, substance abuse, child
care, work/life services, educational resources, marriage counseling, and elder care resources.

Financial Services, when it comes to finances, most of us need a little help now and then. If you would
like to talk with one of our qualified financial specialists, Cigna will provide you with a free 30-minute
consultation. In addition, you can get 25% off on tax preparation when you take advantage of this service.

Legal Services, including referrals and discounts for services, such as creating or modifying a will,
consumer issues, criminal matters, living wills, power of attorney, separation and divorce, and traffic
matters.

Online Resources, information on health and well being, senior care, pet care, drug and alcohol
awareness, relocation services, daycare referrals and more!
Web Address: www.cignabehavioral.com
Member Services: (877) 622-4327
Employer ID: hillsboroughcounty
18
Life & Accidental Death Insurance
Basic Life Insurance
Hillsborough County provides all classified employees with a Basic Life insurance benefit in the
$20,000 at no cost to you.
amount of
For unclassified managers your benefit is equal to $20,000 plus 1x your annual earnings not to exceed
$200,000.
The Plan will also match your Basic Life Insurance benefit for Accidental Death or Dismemberment (AD&D). The
AD&D benefit will provide your beneficiary with an additional amount equal to the life insurance in force if death
is due to an accident. If the employee is dismembered (such as loss of an eye or limb), benefits will be paid to
the employee as a percentage of the AD&D amount.
Beneficiary Information
Please make sure that your beneficiary information is up to date and correct. Please log on to your account on
Oracle Advanced Benefits Employee Self-Serve to designate beneficiaries.
Supplemental Life Insurance
You can purchase supplemental life insurance for yourself and your dependents through Minnesota Life.
Employee rates vary depending on age and benefit amount.

Classified County Employees - You can elect coverage in increments of $10,000 up to a combined Basic Life
and Supplemental Life maximum of $120,000. For your spouse, you can elect either $5,000 or $10,000 and
for your children; $2,500 or $5,000. All amounts are guaranteed issue (no health questions asked) as long as
you enroll in the plan when you are initially eligible*.

Unclassified Managers - You can elect additional coverage in the amounts of two to five times your annual
earnings up to a combined Basic Life and Supplemental Life maximum of $750,000. You can choose to cover
your spouse for $10,000 or $20,000 in coverage and your children for $5,000 or $10,000. If you are electing
supplemental life insurance over $200,000 or you did not enroll when you were initially eligible* you will be
required to complete an evidence of insurability form (health questions) and submit the form to Minnesota
Life for underwriter review.
Voluntary Accidental Death & Dismemberment
You can purchase additional accidental death and dismemberment coverage for yourself and your eligible
dependents.
Employee: Choose an amount in increments of $25,000 not to exceed six times your annual earnings or
$500,000.
Spouse and Children - Spouse 40% of the amount you elected for yourself and for each child 10% of the
amount elected for yourself.
Spouse only - 50% of the amount elected for yourself
Children Only - 15% of the amount elected for yourself.
The maximum amount of coverage for your spouse is $250,000. The maximum amount for each child is
$50,000.
*If you initially declined coverage and want to enroll
Coverage terminates at age 75.
19
at a later date you are considered a late entrant. All
child life amounts are guaranteed issue if elected
initially or during the open enrollment period.
Supplemental Life Contributions
Classified Employee Supplemental Life and AD&D Bi-Weekly Premium (Post-Tax)
Coverage
Amount
Under 25
25.29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
$10,000
$.30
$.40
$.50
$.60
$1.00
$1.60
$1.90
$3.20
$4.90
$7.60
$18.40
$20,000
$.60
$.80
$1.00
$1.20
$2.00
$3.20
$3.80
$6.40
$9.80
$15.20
$36.80
$30,000
$.90
$1.20
$1.50
$1.80
$3.00
$4.80
$5.70
$9.60
$14.70
$22.80
$55.20
$40,000
$1.20
$1.60
$2.00
$2.40
$4.00
$6.40
$7.60
$12.80
$19.60
$30.40
$73.60
$50,000
$1.50
$2.00
$2.50
$3.00
$5.00
$8.00
$9.50
$16.00
$24.50
$38.00
$92.00
$60,000
$1.80
$2.40
$3.00
$3.60
$6.00
$9.60
$11.40
$19.20
$29.40
$45.60
$110.40
$70,000
$2.10
$2.80
$3.50
$4.20
$7.00
$11.20
$13.30
$22.40
$34.30
$53.20
$128.80
$80,000
$2.40
$3.20
$4.00
$4.80
$8.00
$12.80
$15.20
$25.60
$39.20
$60.80
$147.20
$90,000
$2.70
$3.60
$4.50
$5.40
$9.00
$14.40
$17.10
$28.80
$44.10
$68.40
$165.60
$100,000
$3.00
$4.00
$5.00
$6.00
$10.00
$16.00
$19.00
$32.00
$49.00
$76.00
$184.00
Classified Employee Dependent Supplemental Life Bi-Weekly Contribution (Post-Tax)
Coverage Amount
(Spouse to Age 70)
Coverage Amount
(Child(ren) to Age 26)
$5,000
$.70
$2,500
$.25
$10,000
$1.40
$5,000
$.50
Click here for an informative video.
20
Unclassified Employee Supplemental Life Bi-Weekly Premium (Post-Tax)
Age
Under 25
25.29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Cost per
$1,000
$.037
$.042
$.051
$.064
$.106
$.166
$.198
$.328
$.489
$.762
$1.84
Supplemental Life Worksheet
$500,000
Line 1
Maximum Allowable Coverage (1)
Line 2
Enter Amount of Basic Life Coverage (1x annual salary + $20,000) (2)
Line 3
Amount of Supplemental Life Coverage You May Purchase (subtract Line 2 from Line 1) (3)
Line 4
Enter Amount Requested for Supplemental Coverage (1x to 3x your annual salary) (3 & 4)
Line 5
Enter Cost per $1,000 (from table above)
Line 6
Bi-Weekly Cost of Supplemental Life Coverage (Multiple Line 4 by Line 5 and Divide $1,000) (4 & 5)
1.
2.
3.
4.
5.
Maximum allowable coverage for Basic (County paid) plus Supplemental (Employee paid).
Round annual salary to the next higher $1,000 if not a multiple of $1,000.
Supplemental coverage over $200,000 requires Evidence of Insurability.
Round the amount of 1x, 2x, or 3x, to the next $1,000 if not a multiple of $1,000.
Bi-Weekly cost will increase in relation to increases in age and annual salary.
Unclassified Dependent Supplemental Life Bi-Weekly Contribution (Post-Tax)
Coverage Amount
(Spouse to Age 70)
Coverage Amount
(Child(ren) to Age 26)
$10,000
$1.40
$5,000
$.50
$20,000
$2.80
$10,000
$1.00
Voluntary Accidental Death & Dismemberment
Rate per $1,000
Employee
$.03
Family
$.04
21
Disability Benefits
Short Term Disability (STD) Benefits
Hillsborough County provides a Short Term Disability benefit for employees hired on or after February 2,
1997 and for employees who elected to participate in Sick Plan B, at no cost. In the event you become
disabled due to either illness or off-the-job injury and are unable to perform the duties of your job, STD
benefits provide income that supplements your lost wages. After 14 calendar days of your inability to work
due to sickness or personal injury, the plan will provide 75% of your weekly earnings up to, $2,500 per week.
The maximum benefit period is 26 weeks. You are eligible for this benefit the first of the month following
180 days of continuous service.
Long Term Disability (LTD) Benefits
Hillsborough County also provides eligible employees with a Long Term Disability benefit. Long Term
Disability Insurance helps to replace your income if you are sick or injured and cannot work and is designed
to begin after you have been disabled for a pre-determined waiting period. Benefits are as follows:
Class 1 - Employees hired on or after February 2, 1997 or employees hired prior to February 2, 1997 who
have elected to participate in the County’s sick leave plan established February 2, 1997, the plan is provided
at no cost to you. The benefit is equal to 66 2/3% of your pre-disability earnings up to a maximum of $12,000
per month.
Class 2 - Employees hired on or after February 2, 1997 who have elected not to participate in the County’s
sick leave plan established February 2, 1997, the plan is provided at no cost to you. The benefit is equal to
50% of your pre-disability earnings up to a maximum of $12,000 per month.
Class 3 - Employees hired prior to February 2, 1997 who have elected not to participate in the County’s sick
leave plan established February 2, 1997 and who are participating in the Buy-Up Option, you must contribute
toward the cost of the plan. The benefit is equal to 66 2/3% of your pre-disability earnings up to a maximum
of $12,000 per month (when combined with class 2 coverage).
You are eligible to participate in the Long Term Disability Plan after 180 days of continuous service.
22
Retirement Options
Florida Retirement System (FRS)
The Florida Retirement System offers you the option of participating in one of two FRS retirement plans: the FRS
Investment Plan and the FRS Pension Plan. Employees contribute 3% of salary toward their retirement benefit
under FRS.
The FRS Pension Plan is a defined benefit plan, in which you are guaranteed a benefit at retirement if you meet
certain criteria. The amount of your future benefit is determined by a formula, based on your earnings, length of
service, and membership class. Your benefit is pre-funded by contributions paid by you and your employer. You
are fully vested in 8 years.
The FRS Investment Plan is a defined contribution plan in which employer and employee contributions are defined
by law, but your ultimate benefit depends in part on the performance of your investment funds. The FRS
Investment Plan is funded by employer and employee contributions that are based on your salary and FRS
membership class. The Investment Plan directs contributions to individual member accounts, and you allocate your
contributions and account balance among various investment funds. Under the Investment Plan you are fully
vested in one year.
You can get more information at www.myfrs.com. Make sure to register for an account, take advantage of the
videos, workshops and other information available to you.
Deferred Compensation
In addition to the FRS, employees have the option to participate in Deferred Compensation (457) retirement plans.
These tax-deferred, employee-funded plans allow you to have a set amount deducted each paycheck and invested
in select funds. The County will contribute an amount equivalent to 1% of your salary into a deferred compensation
plan of your choice. Enrollment is required to receive this benefit. Maximum annual contribu- tions are determined
by the most current IRS Guidelines. For enrollment and information, contact one of the providers listed below:
Nationwide Retirement Solutions - David Wolfe (813) 763-7026
ICMA - Meghan Doherty (866) 620-6070 ext. 4938
Mass Mutual (Formerly Hartford) - James Waters (727) 270-1171
Click here for an informative video on the importance of saving
for your retirement. Courtesy of ICMA.
23
Voluntary Benefits
Trustmark LifeEvents Universal Life Insurance (with a Long-Term Care Rider)
Universal Life is permanent life insurance that matches the needs of individuals throughout their lifetime. It pays
a higher death benefit during working years when expenses are high. At age 70, when financial needs are
typically lower, the death benefit reduces. Living Benefits, however, do not reduce – they continue throughout
retirement to match the greater need for long-term care.
Premiums for these benefits are paid by you through the convenience of payroll deduction. The benefits are
portable in the event that you leave your employment with the County.
Review the below features and then speak to a Benefit Counselor to learn more and to enroll!
Features
 Long Term Care Rider
 Accelerated Death Benefit
 Coverage available for Employee, Spouse and Children
 Optional Children’s Term Benefit may be added to Employee or Spouse policy in increments of $5,000;
available to age 23 for unmarried, dependent children
 Optional Riders include: Benefit Restoration, Accidental Death, Waiver of Premium and EZValue
Legal Club of America’s SurePathID Identity Theft Solution
Identity theft is the fastest growing financial crime in America, striking thousands of victims each year. SurePath
Identity Theft Solutions provides members with all the components necessary to help prevent online identity
theft, restore an identity in the event it is stolen, and help avoid future identity theft incidents.
Member, plan member’s spouse or domestic partner, dependent children who are under the age of 26 and any
dependent individuals living in the plan member’s home such as a parent or grandparent are eligible.
Features
 Keylogging Defense System™
 Identity Monitoring
 Identity Theft Restoration
 Lost or Stolen Credit Card Assistance / Document Recovery Services (available to employee and eligible
dependents)
 $25,000 Identity Theft Insurance (available to employee only)
 Unlimited Legal Care at Discounted Rates
24
VPI’s Pet Insurance
VPI plans reimburse eligible veterinary expenses relating to accidents, illnesses and injuries for dogs, cats, birds
and exotic pets. Optional CareGuard® protection coverage is also available for routine care. Premium is based
on Species (type of pet), Age of Pet, Breed Size, Plan Type, Deductible, State of Residence. Discounts available
for covering multiple pets.
Available Plans
 Major Medical
 Pet Wellness Basics
 Avian & Exotic
 Injury Plan
 Feline Select Plan
 CareGuard rider may be added to medical plans. This rider offers benefits towards routine treatments
and procedures to help maintain your dog’s good health.
25
Voluntary Benefits
Like most people, you probably rely heavily on your paycheck. What happens if you get sick or hurt and have to be out
of work for an extended period without regular income? Or if you or one of your covered dependents has a serious
accident or illness that causes you to have expenses that are not fully covered by medical insurance?
These Voluntary Benefits can help you and your family with unexpected
expenses arising from illness or injury. The cash benefits are paid directly to you as the insured regardless of any other
insurance you may have.
Premiums for these benefits are paid by you through the convenience of payroll deduction. The benefits are portable in
the event that you leave your employment with The County.
Review the summaries below and then speak to a Benefit Counselor to learn more and to enroll!
Aflac Accident Insurance – Helps provide a financial cushion if an accident occurs





24-hour coverage available
Wellness, Ambulance, and Physical Therapy Benefits
Accidental Death and Dismemberment Benefit
Hospital Confinement Benefit
Optional Riders include: Sickness and Catastrophic Accident
Aflac Critical Illness Insurance - Helps with the medical expenses related to a covered serious health event.




Lump Sum Benefit paid directly to the insured for covered critical illnesses
50% Child benefit
Additional Occurrence and Re-occurrence Benefits
Annual Health Screening Benefit
Aflac Group Short Term Disability Insurance – In the case of illness or injury that leaves you unable to work, this
program provides monthly benefits. Available to employees in Sick Plan A.





24-hour and non-occupational coverage available
Pre-Existing Condition Benefit
Mental Illness Limited Benefit
Alcoholism and Drug Abuse Limited Benefit
Partial Disability Benefit
Aflac Group Hospital Indemnity Insurance – Helps with the non-covered expenses of a hospital stay.






Daily Hospital Confinement Benefit
Intensive Care Benefit
Physician Office Visit/Hospital Emergency Room Visit Benefit
Surgical and Anesthesia Benefit
Variable Hospital Admission Benefit
Wellness Benefit
26
And More……..
Tuition Reimbursement - Employees may be reimbursed up to $1,000 (undergraduate), $2,000
(graduate) per fiscal year for classes at an accredited college or university for courses that enhance your
ability to perform your current job duties.
Direct Deposit - Employees are eligible to have their payroll check deposited directly to the financial
institution of their choice. Up to five financial institutions may be designated.
Holidays - Employees receive up to 12 paid holidays per year (96 hours), including two floating holidays,
based on the date of hire. This is prorated for those employees regularly scheduled to work 20-39 hours
per week.
Annual Leave*- Varies with length of service:
1-4 years: 10 days
5-9 years: 12 days
10-14 years: 15 days
15 or more years: 20 days
Civil Leave - Employees may request leave with pay for an absence to serve jury duty, attend court as a
witness under subpoena, vote in an election, or take County Civil Service tests.
Bereavement Leave - Employees may be granted up to three full working days of paid leave in the event
of the death of a member of the immediate family. This is prorated for those employee regularly
scheduled to work 20-39 hours per week.
Medical Leave - In case of extended illness or injury, an employee must request a medical leave of
absence. Once accumulated sick leave and vacation have been exhausted, the employee will be
responsible for their portion of the premium for the health insurance while they are on a medical leave
of absence.
Family & Medical Leave - In accordance with the Family & Medical Leave Act of 1993 (FMLA), any eligible
employee shall be granted up to 12 weeks of Family & Medical Leave during a 12-month period.
Employees are eligible for FMLA after working at least 1,250 hours in a 12 consecutive month period.
Military Leave - Employees duly called may be granted up to 17 paid leave days in any calendar year.
Newborn Leave - Employees may be granted up to five days of paid leave for the birth of the employee’s
child or the employee’s adoption of a child under the age of eighteen.
Sick Leave* - Employees are eligible to access paid sick leave which is prorated and accrues at the rate of
eight days per year. This can also be used for family illnesses.
***Attendance Award Program: This program is designed to reward employees with great
attendance by allowing an employee to convert a portion of unused sick leave to annual leave.
* This benefit is pro-rated for employees regularly scheduled to work 20-39 hours per week.
27
Important Contacts
Carrier
Line of Coverage
Web Address
Member Services
Medical & Prescription Drug
mycigna.com
800-244-6224
Humana
Dental
www.compbenefits.com/custom/
hillsborough
866-537-0243
Humana
Vision
www.compbenefits.com/custom/
hillsborough
866-537-0243
Life Insurance
www.minnesotalife.com
800-252-5152
Disability Insurance
www.thehartford.com
800-523-2233
Cigna
Employee Assistance Program
www.cignabehavioral.com
Employer ID - Hillsboroughcounty
888-259-6279
Cigna
Flexible Spending Accounts
mycigna.com
800-244-6224
Enrollment Assistance &
Voluntary Products after
7-1-15
www.efpnow.com
844-597-4434
Pet Insurance
www.petinsurance.com
877-263-6008
Aflac
Voluntary Products prior to
7-1-15
www.aflac.com
813-996-2525
Human Resources,
Benefits Support
Services
General Benefit Information
Employee Processing—
Benefits&retirement@hillsborough
county.org
813-272-6400
Option 4
Cigna
Minnesota Life
Hartford
Employee Family
Protection
Nationwide
28
Notes
29
Annual Disclosures
HIPAA Special Enrollment Rights – If you are declining enrollment for yourself and your dependents (including your
spouse) because of other health insurance or group health coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after
your or your dependents’ other coverage ends (or after the employer stops contributing toward the health coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be
able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the mar- riage,
birth, adoption, or placement for adoption.
To request special enrollment or obtain more information, contact Human Resources.
Michelle’s Law – The law allows for continued coverage for dependent children who are covered under your group health
plan as a student if they lose their student status because of a medically necessary leave of absence from school. This
law applies to medically necessary leaves of absence that begin on or after January 1, 2010.
If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of
the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as a
student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions).
Your employer will require a written certification from the child's physician that states that the child is suffering from a
serious illness or injury and that the leave of absence is medically necessary.
Section 111 – Effective January 1, 2009 Group Health Plans are required by Federal government to comply with Section
111 of the Medicare, Medicaid, and SCHIP Extension of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claim assignments. In other words, it will help establish who
pays first. The mandate requires Group Health Plans to collect additional information, more specifically Social Se- curity
Numbers for all enrollees, including dependents six months of age or older. Please be prepared to provide this
information on your Benefit Enrollment Form when enrolling into benefits.
Women’s Health and Cancer Rights Act of 1998 – If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving
mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending
physician and the patient, for:

All stages of reconstruction of the breast on which the mastectomy was performed

Surgery and reconstruction of the other breast to produce a sym- metrical appearance

Prostheses

Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.
The Newborn’s and Mother’s Health Protection Act - Group health plans and health insurance issuers generally may not,
under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn
child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However,
Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother,
from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and
insurers may not, under Federal law, require that a provider obtain authorization from the plan or the insurer for
prescribing a length of stay not more than 48 hours (or 96 hours).
30
Patient Protection: If the Group Health Plan generally requires the designation of a primary care provider, you have the
right to designate any primary care provider who participates in the network and who is available to accept you or your
family members. For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from the carrier or from any other person (including a primary care provider) in
order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.
For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how
to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website.
It is your responsibility to ensure that the information provided on your application for coverage is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation.
Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your
state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP
programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance
programs but you may be able to buy individual insurance coverage through the Health Insurance Market- place. For
more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your
State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your depend- ents
might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you
pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your
employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called
a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for
premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at
www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2016. Contact your State for more information on eligibil- ity
.
31
Annual Disclosures
ALABAMA - Medicaid
MAINE - Medicaid
Website: www.myalhipp.com
Phone: 1-855-692-5447
Website: http://www.maine.gov/dhhs/ofi/public-assistance/
index.html
Phone: 1-800-442-6003
ALASKA - Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email: [email protected]
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/
medicaid/default.aspx
MASSACHUSETTS - Medicaid and CHIP
Website: http://www.mass.gov/MassHealth
MINNESOTA - Medicaid
ARKANSAS - Medicaid
Website: http://mn.gov/dhs/ma
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
MISSOURI - Medicaid
COLORADO - Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/
hipp.htm
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Care Center: 1-800-221-3943
FLORIDA - Medicaid
MONTANA - Medicaid
Website: https://www.flmedicaidtplrecovery.com/hipp
Phone: 1-877-357-3268
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/
HIPP
GEORGIA - Medicaid
Website: http://dch.georgia.gov/medicaid
Click on Health Insurance Premium Payment (HIPP)
Phone: 1-404-656-4507
NEBRASKA - Medicaid
Website: http://dhhs.ne.gov/Children_Family_Services/
AccessNebraska/Pages/accessnebraska_index.aspx
Phone: 1-855-632-7633
INDIANA - Medicaid
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.hip.in.gov
Phone: 1-877-438-4479
All other Medicaid
Website: http://www.indianamedicaid.com
Phone 1-800-403-0864
NEVADA - Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE - Medicaid
IOWA - Medicaid
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Website: www.dhs.state.ia.us/hipp/
NEW JERSEY - Medicaid and CHIP
KANSAS - Medicaid
Medicaid Website: http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
MedicaidPhone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
Website: http://www.kdheks.gov/hcf/
KENTUCKY - Medicaid
NEW YORK - Medicaid
Website: http://chfs.ky.gov/dms/default.htm
Website: http://www.nyhealth.gov/health_care/medicaid/
LOUISIANA - Medicaid
NORTH CAROLINA - Medicaid
Website: http://dhh.louisiana.gov/index.cfm/
subhome/1/n/331
32
Website: http://www.ncdhhs.gov/dma
UTAH - Medicaid and CHIP
NORTH DAKOTA - Medicaid
Website: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
Phone: 1-877-543-7669
Website: http://www.nd.gov/dhs/services/medicalserv/
medicaid/
Phone: 1-844-854-4825
VERMONT - Medicaid
OKLAHOMA - Medicaid and CHIP
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
VIRGINIA - Medicaid and CHIP
OREGON - Medicaid
Website: http://www.oregonhealthykids.gov
http://www.hijossaludablesoregon.gov
Phone: 1-800-699-9075
Medicaid Website: http://www.coverva.org/
programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website: http://www.coverva.org/
programs_premium_assistance.cfm
PENNSYLVANIA - Medicaid
Website: http://www.dhs.pa.gov/hipp
Phone: 1-800-692-7462
WASHINGTON - Medicaid
Website: http://www.hca.wa.gov/medicaid/premiumpymt/
pages/index.aspx
RHODE ISLAND- Medicaid
Website: www.eohhs.ri.gov
Phone: 401-462-5300
WEST VIRGINIA - Medicaid
SOUTH CAROLINA - Medicaid
Website: http://www.dhhr.wv.gov/bms/Medicaid%
20Expansion/Pages/default.aspx
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
WISCONSIN - Medicaid and CHIP
SOUTH DAKOTA - Medicaid
Website:
https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Website: http://dss.sd.gov
Phone: 1-888-828-0059
WYOMING - Medicaid
TEXAS - Medicaid
Website: https://wyequalitycare.acs-inc.com/
Website: https://www.gethipptexas.com/
Phone: 1-800-440-0493
To see if any other states have added a premium assistance program since July 31, 2016, or for more information
on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
33
Medicare D Notice
Important Notice from Hillsborough County About Your Prescription Drug Coverage
and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current
prescription drug coverage with Hillsborough County and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are
considering joining, you should compare your current coverage, including which drugs are covered at what cost,
with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information
about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug
coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or
PPO) that offers prescription drug coverage. All Medicare drug plans provide a minimum standard level of
coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Hillsborough County has determined that the prescription drug coverage administered by Cigna is, on average
for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays
and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage,
you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare
drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th
through December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also
be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Hillsborough County coverage will not be affected.
If you do decide to join a Medicare drug plan and drop your current Hillsborough County coverage, be aware that
you and your dependents may not be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Hillsborough County and don’t join a
Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a
penalty) to join a Medicare drug plan later.
34
Important Notice from Hillsborough County About Your Prescription Drug Coverage
and Medicare (continued)
If you have 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may
go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have
that coverage. For example, if you leave nineteen months without creditable coverage, your premium may
consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher
premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait
until the following October to join.
For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further information. NOTE: This notice will be updated each year. You will
receive it before the next period you can join a Medicare drug plan and if this coverage through Hillsborough County
changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You”
handbook. You will receive a copy of the handbook in the mail from Medicare every year. You may also be
contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the
“Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available.
For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to
join one of the Medicare drug plans, you may be required to provide
a copy of this notice when you join to show whether or not you have
maintained creditable coverage and, therefore, whether or not you are
required to pay a higher premium (a penalty).
Date:
Name of Entity/Sender:
Contact--Position/Office:
Address:
Phone Number:
October 2016
Hillsborough County
Human Resources
601 E. Kennedy Blvd. Tampa, FL 33602
(813) 272-6400 Option 4
35
The information in this guide is a summary of the benefits available to you and should not be intended to take the
place of the official carriers’ Member Certificates or our plan’s Summary Plan Descriptions (SPD). This guide contains
a general description of the benefits to which you and your eligible dependents may be entitled as a fulltime
employee. This guide does not change or otherwise interpret the terms of the official plan documents. To the extent
that any of the information contained in this guide is inconsistent with the official plan documents, the provisions of
the official documents will govern in all cases and the plan documents and carrier certificates will prevail.
Hillsborough County BOCC reserves the right, in its sole and absolute discretion, to amend, modify or terminate, in
whole or in part, any or all of the provisions of the benefit plans.
This Benefits Guide is a Presentation Prepared by